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Niškanović J, Stojisavljević D, Stojisavljević S, Djikanovic B, Manigoda D. Exploring possibilities for the development of healthy eating habits in preschool settings: parent's and teacher's perspectives. Food Sci Nutr 2024; 12:1616-1626. [PMID: 38455201 PMCID: PMC10916589 DOI: 10.1002/fsn3.3853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 03/09/2024] Open
Abstract
Adoption of eating habits starts early in life, through interaction with family members and alongside preschool settings that offer context for developing healthy lifestyles among children. The aim of this study was to explore the perceptions and practices of teachers and parents related to the development of healthy eating habits among preschool children. Focus groups were conducted with a total sample of 48 parents and teachers (three focus groups among parents and three among teachers) from 15 kindergartens in the Republic of Srpska, Bosnia, and Herzegovina. All of the mentioned kindergartens are part of the "Nutrition friendly preschool/school initiative", a program aimed at creating and developing settings that support and improve children's health. Focus groups were audiotaped, transcribed verbatim, and analyzed according to the Framework Method. Teachers emphasized that good communication and support from parents are important factors for the development of healthy eating habits. During COVID-19, direct communication with parents was restricted, and mutual activities among teachers, children, and parents were reduced. Lack of knowledge, finance, and time are perceived by parents as main obstacles to the improvement of children's healthy eating habits. All participants in the focus groups agreed that more education and informative material are needed so their skills related to good nutrition can be improved and adopted in a culture-sensitive way. Mutual support, education, and dissemination of informative materials are imposed as particularly important needs by all actors involved in the upbringing of children in order to support the development of children's healthy eating habits.
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Affiliation(s)
- Jelena Niškanović
- Public Health Institute of the Republic of SrpskaBanja LukaBosnia and Herzegovina
| | - Dragana Stojisavljević
- Public Health Institute of the Republic of SrpskaBanja LukaBosnia and Herzegovina
- Faculty of MedicineUniversity of Banja LukaBanja LukaBosnia and Herzegovina
| | - Stela Stojisavljević
- Public Health Institute of the Republic of SrpskaBanja LukaBosnia and Herzegovina
- Faculty of MedicineUniversity of Banja LukaBanja LukaBosnia and Herzegovina
| | - Bosiljka Djikanovic
- Institute of Social Medicine, Faculty of MedicineUniversity of BelgradeBelgradeSerbia
| | - Dijana Manigoda
- Public Health Institute of the Republic of SrpskaBanja LukaBosnia and Herzegovina
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Gago C, Aftosmes-Tobio A, Beckerman-Hsu JP, Oddleifson C, Garcia EA, Lansburg K, Figueroa R, Yu X, Kitos N, Torrico M, Leonard J, Jurkowski JK, Mattei J, Kenney EL, Haneuse S, Davison KK. Evaluation of a cluster-randomized controlled trial: Communities for Healthy Living, family-centered obesity prevention program for Head Start parents and children. Int J Behav Nutr Phys Act 2023; 20:4. [PMID: 36631869 PMCID: PMC9832428 DOI: 10.1186/s12966-022-01400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families. METHODS Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one of three intervention start times. CHL involved a media campaign and enhanced nutrition support. Parents were invited to join Parents Connect for Healthy Living (PConnect), a 10-week wellness program. At the beginning and end of each school year (2017-2019), data were collected on the primary outcome of child Body Mass Index z-score (BMIz) and modified BMIz, and secondary outcomes of child weight-related behaviors (diet, physical activity, sleep, media use) and parents' weight-related parenting practices and empowerment. Data from 2 years, rather than three, were utilized to evaluate CHL due to the COVID-19 pandemic. We used mixed effects linear regression to compare relative differences during intervention vs. control periods (n = 1274 vs. 2476 children) in (1) mean change in child BMIz and modified BMIz, (2) the odds of meeting child health behavior recommendations, (3) mean change in parenting practices, and (4) mean change in parent empowerment. We also compared outcomes among parents who chose post-randomization to participate in PConnect vs. not (n = 55 vs. 443). RESULTS During intervention periods (vs. control), children experienced greater increases in BMIz and modified BMIz (b = 0.06, 95% CI = 0.02,0.10; b = 0.07, 95% CI = 0.03, 0.12), yet were more likely to meet recommendations related to three of eight measured behaviors: sugar-sweetened beverage consumption (i.e., rarely consume; Odds Ratio (OR) = 1.5, 95% CI = 1.2,2.3), water consumption (i.e., multiple times per day; OR = 1.6, 95% CI = 1.2,2.3), and screen time (i.e., ≤1 hour/day; OR = 1.4, 95% CI = 1.0,1.8). No statistically significant differences for intervention (vs. control) periods were observed in parent empowerment or parenting practices. However, parents who enrolled in PConnect (vs. not) demonstrated greater increases in empowerment (b = 0.17, 95% CI = 0.04,0.31). CONCLUSIONS Interventions that emphasize parent engagement may increase parental empowerment. Intervention exposure was associated with statistically, but not clinically, significant increases in BMIz and increased odds of meeting recommendations for three child behaviors; premature trial suspension may explain mixed results. TRIAL REGISTRATION ClinicalTrials.gov, NCT03334669 , Registered October 2017.
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Affiliation(s)
- Cristina Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Alyssa Aftosmes-Tobio
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Jacob P Beckerman-Hsu
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Carly Oddleifson
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Evelin A Garcia
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kindra Lansburg
- Action for Boston Community Development (ABCD), Boston, MA, 02111, USA
| | - Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Xinting Yu
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Nicole Kitos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Merieka Torrico
- Action for Boston Community Development (ABCD), Boston, MA, 02111, USA
| | - Jessie Leonard
- Community Action Agency of Somerville (CAAS), Somerville, MA, 02143, USA
| | - Janine K Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York, Albany, NY, 12222, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kirsten K Davison
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA.
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Coto J, Graziano PA. Targeting Pediatric Obesity via a Healthy Lifestyle Summer Camp Intervention: How Necessary Is a Parenting Component? Child Obes 2022; 18:350-359. [PMID: 34905411 DOI: 10.1089/chi.2021.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Pediatric obesity represents a significant public health concern, especially for Hispanic school-aged children. This study examined via a randomized trial the efficacy of a family-based intervention [Healthy Lifestyle Summer Camp and Parenting program (HLSC+HLPP)] compared with a child-based camp intervention [Healthy Lifestyle Summer Camp (HLSC)] on improving child and parent health outcomes. Methods: Participants included 24 children (n = 11 HLSC+HLPP; n = 13 HLSC) with a mean age of 6.17 years (range 4-9 years) who were mostly Hispanic (87.5%) and were classified as overweight or obese, and their primary caregiver. Various anthropometric, physical activity, nutrition, and parenting outcomes were collected pre-/post-intervention. Results: Results indicated that both interventions were feasible and acceptable. There were no statistically significant differences between groups; however, both groups demonstrated a decrease in child BMI z-score (HLSC+HLPP: g = -0.31; HLSC: g = -0.31) and increase in child fitness (HLSC+HLPP: g = 1.70; HLSC: g = 1.77), nutritional health classification (HLSC+HLPP: g = 1.54; HLSC: g = 0.82), nutrition expressive knowledge (HLSC+HLPP: g = 1.03; HLSC: g = 1.06), and parental monitoring (HLSC+HLPP: g = 0.51; HLSC: g = 0.49) after the intervention. Conclusions: These findings highlight the feasibility, acceptability, and improvement of child health outcomes after both interventions. Future research should examine group differences during a follow-up period as well as employ a larger sample.
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Affiliation(s)
- Jennifer Coto
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paulo A Graziano
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA
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Jones A, Armstrong B, Weaver RG, Parker H, von Klinggraeff L, Beets MW. Identifying effective intervention strategies to reduce children's screen time: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:126. [PMID: 34530867 PMCID: PMC8447784 DOI: 10.1186/s12966-021-01189-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excessive screen time ([Formula: see text] 2 h per day) is associated with childhood overweight and obesity, physical inactivity, increased sedentary time, unfavorable dietary behaviors, and disrupted sleep. Previous reviews suggest intervening on screen time is associated with reductions in screen time and improvements in other obesogenic behaviors. However, it is unclear what study characteristics and behavior change techniques are potential mechanisms underlying the effectiveness of behavioral interventions. The purpose of this meta-analysis was to identify the behavior change techniques and study characteristics associated with effectiveness in behavioral interventions to reduce children's (0-18 years) screen time. METHODS A literature search of four databases (Ebscohost, Web of Science, EMBASE, and PubMed) was executed between January and February 2020 and updated during July 2021. Behavioral interventions targeting reductions in children's (0-18 years) screen time were included. Information on study characteristics (e.g., sample size, duration) and behavior change techniques (e.g., information, goal-setting) were extracted. Data on randomization, allocation concealment, and blinding was extracted and used to assess risk of bias. Meta-regressions were used to explore whether intervention effectiveness was associated with the presence of behavior change techniques and study characteristics. RESULTS The search identified 15,529 articles, of which 10,714 were screened for relevancy and 680 were retained for full-text screening. Of these, 204 studies provided quantitative data in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of screen time interventions compared to controls (SDM = 0.116, 95CI 0.08 to 0.15). Inclusion of the Goals, Feedback, and Planning behavioral techniques were associated with a positive impact on intervention effectiveness (SDM = 0.145, 95CI 0.11 to 0.18). Interventions with smaller sample sizes (n < 95) delivered over short durations (< 52 weeks) were associated with larger effects compared to studies with larger sample sizes delivered over longer durations. In the presence of the Goals, Feedback, and Planning behavioral techniques, intervention effectiveness diminished as sample size increased. CONCLUSIONS Both intervention content and context are important to consider when designing interventions to reduce children's screen time. As interventions are scaled, determining the active ingredients to optimize interventions along the translational continuum will be crucial to maximize reductions in children's screen time.
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Affiliation(s)
- Alexis Jones
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Bridget Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - R. Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Hannah Parker
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Lauren von Klinggraeff
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - M. W. Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
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Patel AI, Hecht CE, Cradock A, Edwards MA, Ritchie LD. Drinking Water in the United States: Implications of Water Safety, Access, and Consumption. Annu Rev Nutr 2020; 40:345-373. [PMID: 32966189 DOI: 10.1146/annurev-nutr-122319-035707] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent water quality crises in the United States, and recognition of the health importance of drinking water in lieu of sugar-sweetened beverages, have raised interest in water safety, access, and consumption. This review uses a socioecological lens to examine these topics across the life course. We review water intakes in the United States relative to requirements, including variation by age and race/ethnicity. We describe US regulations that seek to ensure that drinking water is safe to consume for most Americans and discuss strategies to reduce drinking water exposure to lead, a high-profile regulated drinking water contaminant. We discuss programs, policies, and environmental interventions that foster effective drinking water access, a concept that encompasses key elements needed to improve water intake. We conclude with recommendations for research, policies, regulations, and practices needed to ensure optimal water intake by all in the United States and elsewhere.
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Affiliation(s)
- Anisha I Patel
- Division of General Pediatrics, Stanford University, Palo Alto, California 94305, USA
| | - Christina E Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California 94704, USA;
| | - Angie Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
| | - Marc A Edwards
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California 94704, USA;
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PCIT-Health: Preventing Childhood Obesity by Strengthening the Parent–Child Relationship. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Franse CB, Boelens M, Fries LR, Constant F, van Grieken A, Raat H. Interventions to increase the consumption of water among children: A systematic review and meta-analysis. Obes Rev 2020; 21:e13015. [PMID: 32167233 PMCID: PMC7317453 DOI: 10.1111/obr.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 12/17/2022]
Abstract
The aim of this study was to conduct a systematic review and meta-analysis on the effectiveness of interventions to increase children's water consumption. A systematic literature search was conducted in seven electronic databases. Studies published in English before 18 February 2019 that evaluated any type of intervention that measured change in water consumption among children aged 2 to 12 years by applying any type of design were included. Of the 47 interventions included in the systematic review, 24 reported a statistically significant increase in water consumption. Twenty-four interventions (17 randomized controlled trials and seven studies with other controlled designs) were included in the meta-analysis. On average, children in intervention groups consumed 29 mL/d (confidence interval [CI] = 13-46 mL/d) more water than did children in control groups. This effect was larger in eight interventions focused specifically on diet (MD = 73 mL/d, CI = 20-126 mL/d) than in 16 interventions focused also on other lifestyle factors (MD = 15 mL/d, CI = 1-29 mL/d). Significant subgroup differences were also found by study setting and socioecological level targeted but not by children's age group, intervention strategy, or study design. In conclusion, there is evidence that, on average, lifestyle interventions can lead to small increases in children's daily water consumption. More research is needed to further understand the specific intervention elements that have the greatest effect.
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Affiliation(s)
- Carmen B. Franse
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Mirte Boelens
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | | | | | - Amy van Grieken
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Hein Raat
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
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Cradock AL, Poole MK, Agnew KE, Flax C, Plank K, Capdarest-Arest N, Patel AI. A systematic review of strategies to increase drinking-water access and consumption among 0- to 5-year-olds. Obes Rev 2019; 20:1262-1286. [PMID: 31250960 DOI: 10.1111/obr.12833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/10/2018] [Accepted: 12/27/2018] [Indexed: 12/12/2022]
Abstract
The objective of this study is to identify promising strategies for improving drinking-water access and consumption among children aged 0 to 5 years. MEDLINE/PubMed, Embase, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched in this review. Studies included peer-reviewed, full-text studies from high-income countries, published in English between January 1, 2000, and January 12, 2018, that evaluated interventions to increase water access or consumption in children aged 0 to 5 years. Twenty-five studies met inclusion criteria; 19 used an effective intervention strategy to increase water access or water consumption. Three studies addressed both water access and consumption. Frequently used strategies included policy and practice changes, increasing water access and convenience, and education, training, or social support for caregivers. Studies were of fair methodological quality (average score: 18.8 of 26) for randomized studies and of moderate quality (5.1 of 9) for non-randomized studies. To date, few high-quality studies with objectively measured outcomes have clearly demonstrated strategies that may influence water intake and consumption among young children aged 0 to 5 years.
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Affiliation(s)
- Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary Kathryn Poole
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kaylan E Agnew
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Chasmine Flax
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kaela Plank
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA, USA
| | | | - Anisha I Patel
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Department of Pediatrics, Stanford University, Stanford, CA, USA
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Reilly JJ, Hughes AR, Gillespie J, Malden S, Martin A. Physical activity interventions in early life aimed at reducing later risk of obesity and related non-communicable diseases: A rapid review of systematic reviews. Obes Rev 2019; 20 Suppl 1:61-73. [PMID: 31419046 DOI: 10.1111/obr.12773] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 08/30/2018] [Accepted: 09/01/2018] [Indexed: 12/15/2022]
Abstract
To identify useful components of interventions aimed at prevention of childhood obesity and related non-communicable diseases (NCDs), which included physical activity and which targeted any or all of four life-course stages: peri-conception; pregnancy; infancy and toddlerhood (0 to 23 months); and early childhood (24 to 59 months). In May 2016, WHO Geneva searched the Cochrane Library and PubMed for systematic reviews of interventions including physical activity to prevent childhood obesity or risk factors for obesity-related NCDs. Using a narrative synthesis, the efficacy of randomized controlled trials (RCTs) to alter energy balance outcomes (measures of weight status or body fatness) was characterized by life-course stage, study characteristics, intervention functions (as defined in the behaviour change wheel), and level of the socio-ecological model (SEM) targeted. The quality of included systematic reviews was assessed. We retrieved 82 reviews from the World Health Organization (WHO) search, of which 23 were eligible for the present synthesis. The number of eligible studies by life-course stage was: 0 (peri-conception); 0 (pregnancy); 8 (infancy and toddlerhood, age 0 to 23 months; seven RCTs; age); and 37 (early childhood, age 24 to 59 months; 30 RCTs;). Thus, there was a lack of evidence for physical activity interventions during peri-conception and pregnancy. Almost all relevant studies in the 0- to 23- and 24- to 59-month life-course stages were multicomponent interventions (ie, targeted physical activity, dietary, and/or sedentary behaviours). Interventions with evidence of efficacy tended to target multiple levels of the SEM, with emphasis on parents, and extend over long periods. Effective intervention elements for early life obesity prevention included classes on parenting skills, alteration of the kindergarten playground, and financial incentives. Evidence from low- and middle-income countries was scarce, and evidence for intervention effect on obesity-related NCDs was missing. Future physical activity interventions in toddlerhood and early childhood aimed at prevention of obesity should adopt the characteristics typical of effective interventions identified by the present synthesis. There is an urgent need for more evidence on physical activity interventions set in low- and middle-income countries and which target the peri-conception and pregnancy periods.
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Affiliation(s)
- John J Reilly
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Adrienne R Hughes
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Jennifer Gillespie
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Stephen Malden
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Anne Martin
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK.,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Brown T, Moore TH, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 275] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
EDITORIAL NOTE This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024. BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
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Affiliation(s)
- Tamara Brown
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
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11
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Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, Summerbell CD. WITHDRAWN: Interventions for treating obesity in children. Cochrane Database Syst Rev 2019; 3:CD001872. [PMID: 30843601 PMCID: PMC6404387 DOI: 10.1002/14651858.cd001872.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences. OBJECTIVES To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood. SEARCH METHODS We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information. MAIN RESULTS We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs. AUTHORS' CONCLUSIONS While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required.
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Affiliation(s)
- Hiltje Oude Luttikhuis
- University Medical Center GroningenBeatrix Children's Hospital and Department of EpidemiologyPO Box 30.001 (CA80)9700RBGroningenNetherlands
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Hanneke Jansen
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CareP.O.Box 85500UtrechtNetherlands3508 AB
| | - Vanessa A Shrewsbury
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Ronald P Stolk
- University Medical Center GroningenDepartment of EpidemiologyGroningenNetherlands
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Science42 Old ElvetDurhamUKDH13HN
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JaKa MM, French SA, Wolfson J, Jeffery RW, Lorencatto F, Michie S, Levy RL, Langer SL, Sherwood NE. Understanding Outcomes in Behavior Change Interventions to Prevent Pediatric Obesity: The Role of Dose and Behavior Change Techniques. HEALTH EDUCATION & BEHAVIOR 2018; 46:312-321. [PMID: 30215279 DOI: 10.1177/1090198118798679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Behavioral interventions to prevent pediatric obesity have shown inconsistent results across the field. Studying what happens within the "black box" of these interventions and how differences in implementation lead to different outcomes will help researchers develop more effective interventions. AIM To compare the implementation of three features of a phone-based intervention for parents (time spent discussing weight-related behaviors, behavior change techniques used in sessions, and intervention activities implemented by parents between sessions) with study outcomes. METHODS A random selection of 100 parent-child dyads in the intervention arm of a phone-based obesity prevention trial was included in this analysis. Sessions were coded for overall session length, length of time spent discussing specific weight-related behaviors, number of behavior change techniques used during the sessions, and number of intervention-recommended activities implemented by the parents between sessions (e.g., parent-reported implementation of behavioral practice/rehearsal between sessions). The primary study outcome, prevention of unhealthy increase in child body mass index (BMI) percentile, was measured at baseline and 12 months. RESULTS Overall session length was associated with decreases in child BMI percentile ( b = -0.02, p = .01). There was no association between the number of behavior change techniques used in the sessions and decreases in child BMI percentile ( b = -0.29, p = .27). The number of activities the parents reported implementing between sessions was associated with decreases in child BMI percentile ( b = -1.25, p = .02). DISCUSSION To improve future interventions, greater attention should be paid to the intended and delivered session length, and efforts should be made to facilitate parents' implementation of intervention-recommended activities between sessions (ClinicalTrials.gov, No. NCT01084590).
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Affiliation(s)
- Meghan M JaKa
- 1 DC Department of Behavioral Health, Applied Research and Evaluation, Washington, DC, USA
| | | | | | | | | | | | - Rona L Levy
- 5 University of Washington, Seattle, WA, USA
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13
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Ahmad N, Shariff ZM, Mukhtar F, Lye MS. Family-based intervention using face-to-face sessions and social media to improve Malay primary school children's adiposity: a randomized controlled field trial of the Malaysian REDUCE programme. Nutr J 2018; 17:74. [PMID: 30071855 PMCID: PMC6090983 DOI: 10.1186/s12937-018-0379-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/10/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Social media may be an effective medium by which parents could be trained to promote healthy eating behaviour and physical activity for their children. This trial evaluates the effectiveness of a family-based intervention using social media in combination with face-to-face sessions - the REDUCE (REorganise Diet, Unnecessary sCreen time and Exercise) programme - on adiposity of Malay children. METHODS Five primary schools in an urban area in Selangor, Malaysia participated in this two-arm randomized controlled field trial. Participants were parents (n = 134) and their primary school-going children 8-11 years of age who were either overweight or obese. These parent-child dyads were randomly allocated to intervention and wait-list control groups and were blinded to group assignment. The intervention was a four-week training programme using two face-to-face sessions and two Facebook sessions followed by weekly booster sessions over a three-month period using WhatsApp. The primary outcome was body mass index (BMI) z-score. Height, body weight, waist circumference and percentage of body fat were measured by blinded assessors. Data were collected at baseline (T1), immediately post-training (T2) and at three- (T3) and six-month post training (T4) and were analysed using generalized linear mixed modelling adjusted for covariates to estimate the intervention effects. Subgroup analysis was conducted for overweight and obese children. RESULTS Ninety-one percent of parents completed the study, 64 in intervention group and 58 in wait-list group. At the sixth month post-training, BMI z-scores were significantly reduced in the intervention group compared to the wait-list group, for the all children (overweight and obese children) and within the obese subgroup ((F(6, 517) = 2.817, p = 0.010) and (F(6, 297) = 6.072, p < 0.001) respectively. For waist circumference percentile and body fat percentage, the intervention group experienced a significant reduction compared to the wait-list group, within the obese subgroup ((F(6, 297) = 3.998, p = 0.001) and within the overweight subgroup (F(6, 201) = 2.526, p = 0.022). CONCLUSIONS The four-month REDUCE intervention programme was effective in reducing childhood adiposity. Further research using this approach needs to be conducted including cost-effectiveness studies before implementing it in a child obesity prevention programme. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12617000844347 (7 June 2017 retrospectively registered). National Medical Research Register, Ministry of Health Malaysia: NMRR-14-685-21,874 (July 2014).
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Affiliation(s)
- Norliza Ahmad
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Level 1, Block B (Academic), 43400 UPM, Serdang, Selangor, Malaysia
| | - Zalilah Mohd Shariff
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Firdaus Mukhtar
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Munn-Sann Lye
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Level 1, Block B (Academic), 43400 UPM, Serdang, Selangor, Malaysia.
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14
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Xu J, Hardy LL, Guo CZ, Garnett SP. The trends and prevalence of obesity and morbid obesity among Australian school-aged children, 1985-2014. J Paediatr Child Health 2018; 54:907-912. [PMID: 29667237 DOI: 10.1111/jpc.13922] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/24/2018] [Accepted: 03/08/2018] [Indexed: 12/25/2022]
Abstract
AIM Children with obesity have a greater risk of adverse social and physical health outcomes. We examined temporal changes in body mass index (BMI) z-scores and the prevalence obesity and morbid obesity in children from 1985 to 2014. METHODS Secondary data analysis of BMI data for children aged 7-15 years from five cross-sectional Australian datasets. Changes in age- and gender-adjusted BMI (BMI z-scores) and nutritional status were categorised using the International Obesity Task Force cut-off points. RESULTS The percentage of children who were obese tripled between 1985 and 1995 from 1.6 to 4.7%, before plateauing between 1995 and 2014. The percentage of morbidly obese children was <1% in 1985 and 1995, increasing to 2% between 1995 and 2007, with no further increase between 2007 and 2014. The proportion of obese children classified as morbidly obese was 12% in 1985-1995, 24% in 2007-2012 and 28% in 2014. Between 1985 and 2012, the mean BMI z-score increased in children categorised as obese from 1.94 (standard deviation 0.15) to 2.03 (0.22), and then plateaued. For morbidly obese children, the mean BMI z-score was 2.4 (0.13) and remained similar over the study period. CONCLUSIONS Our findings suggest that the relative fatness of children with morbid obesity, as measured by BMI z-score, has remained stable. The proportion of obese and morbidly obese children has also plateaued between 2007 and 2014. However, the prevalence of obesity remains high, and more dedicated resources are required to treat children with obesity to reduce the short- and long-term health impact.
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Affiliation(s)
- Joshua Xu
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Louise L Hardy
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Cici Z Guo
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah P Garnett
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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15
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Kobes A, Kretschmer T, Timmerman G, Schreuder P. Interventions aimed at preventing and reducing overweight/obesity among children and adolescents: a meta-synthesis. Obes Rev 2018; 19:1065-1079. [PMID: 29671938 DOI: 10.1111/obr.12688] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 12/30/2022]
Abstract
The prevalence of child and adolescent obesity has been a major worldwide problem for decades. To stop the number of youth with overweight/obesity from increasing, numerous interventions focusing on improving children's weight status have been implemented. The growing body of research on weight-related interventions for youth has been summarized by several meta-analyses aiming to provide an overview of the effectiveness of interventions. Yet, the number of meta-analyses is expanding so quickly and overall results differ, making a comprehensive synopsis of the literature difficult. To tackle this problem, a meta-synthesis was conducted to draw informed conclusions about the state of the effectiveness of interventions targeting child and adolescent overweight. The results of the quantitative synthesis of 26 meta-analyses resulted in a standardized mean difference (SMD) of -0.12 (95%CI: -0.16, -0.08). Several moderator analyses showed that participant and intervention characteristics had little impact on the overall effect size. However, a moderator analysis distinguishing between obesity treatment and obesity prevention studies showed that obesity treatment interventions (SMD: -0.048, 95%CI: -0.60, -0.36) were significantly more effective in reducing body mass index than obesity prevention interventions (SMD: -0.08, 95%CI: -0.11, -0.06). Overall, the results of this meta-synthesis suggest that interventions result in statistically significant effects albeit of relatively little clinical relevance.
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Affiliation(s)
- A Kobes
- Department of Pedagogy and Educational Sciences, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - T Kretschmer
- Department of Pedagogy and Educational Sciences, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - G Timmerman
- Department of Pedagogy and Educational Sciences, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - P Schreuder
- Department of Pedagogy and Educational Sciences, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
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16
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Alulis S, Grabowski D. Theoretical frameworks informing family-based child and adolescent obesity interventions: A qualitative meta-synthesis. Obes Res Clin Pract 2017; 11:627-639. [PMID: 28844833 DOI: 10.1016/j.orcp.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/10/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Child and adolescent obesity trends are rising throughout the world, revealing treatment difficulties and a lack of consensus about treatment. The family system is broadly viewed as a potential setting for facilitation of behaviour change. Therefore, family-based interventions have come into focus. However, the use of theoretical frameworks to strengthen these interventions is rare and very uneven. OBJECTIVE AND METHOD To conduct a qualitative meta-synthesis of family-based interventions for child and adolescent obesity to identify the theoretical frameworks applied, thus understanding how theory is used in practice. A literature review was conducted between January and March 2016. A total of 35 family-based interventions were selected for analysis. RESULTS Eleven interventions explicitly stated that theory guided the development and were classified as theory-inspired. The social cognitive, self-efficacy and Family Systems Theory appeared most frequently. The remaining 24 were classified as theory-related as theoretical elements of self-monitoring; stimulus control, reinforcement and modelling were used. CONCLUSION The designs of family-based interventions reveal numerous inconsistencies and a significant void between research results and health care practice. Based on the analysis, this article proposes three themes to be used as focus points when designing future interventions and when selecting theories for the development of solid, theory-based frameworks for application. The themes are: (1) age of target group, (2) intervention objective, and (3) self-efficacy and readiness for change.
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Affiliation(s)
- Sarah Alulis
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark; Lund University, Paradisgatan 2, 221 00 Lund, Sweden.
| | - Dan Grabowski
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark.
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Sekhobo JP, Peck SR, Byun Y, Allsopp MAK, Holbrook MK, Edmunds LS, Yu C. Use of a mixed-method approach to evaluate the implementation of retention promotion strategies in the New York State WIC program. EVALUATION AND PROGRAM PLANNING 2017; 63:7-17. [PMID: 28319784 DOI: 10.1016/j.evalprogplan.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/17/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
This research assessed the implementation of strategies piloted at 10 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics aimed at increasing retention in the program, by enhancing participants' shopping experiences. Under WIC Retention Promotion Study: Keep, Reconnect, Thrive (WIC RPS), clinics were recruited and assigned to implement one or a combination of strategies: a standardized Shopping Orientation (SO) curriculum, a Guided Shopping Tour (GST), and a Pictorial Foods Card (PFC) from November 2012 through August 2013. This paper presents results from the process evaluation of the retention strategies, using a mixed-methods comparative case study design employing WIC administrative data, interviews, and focus groups. Qualitative data were inductively coded, analyzed and mapped to the following implementation constructs: organizational capacity, fidelity, allowable adaptations, implementation challenges, and participant responsiveness, while quantitative data were analyzed using SAS to assess reach and dose. Several sites implemented the SO and PFC interventions with the necessary fidelity and dose needed to assess impact on participants' shopping experiences. Sites that were assigned the GST strategy struggled to implement this strategy. However, use of the standardized SO enabled staff to use a "consistent list of shopping tips" to educate participants about the proper use of checks, while use of the PFC increased participants' awareness of the variety of WIC-allowable foods. During follow-up telephone calls, 91 percent of participants reported the shopping tips as helpful. Future analyses will assess the impact of enhanced shopping experience on retention at intervention sites.
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Affiliation(s)
- Jackson P Sekhobo
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA.
| | - Sanya R Peck
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA
| | - Youjung Byun
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA; Graduate Student, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer 12144, NY, USA
| | - Marie A K Allsopp
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA; Graduate Student, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer 12144, NY, USA
| | - MaryEllen K Holbrook
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA
| | - Lynn S Edmunds
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA
| | - Chengxuan Yu
- Division of Nutrition, New York State Department of Health, 150 Broadway, Suite 517, Menands 12204, NY, USA
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JaKa MM, Seburg EM, French SA, Wolfson J, Jeffery RW, Levy RL, Langer SL, Sherwood NE. Parent Choice in a Pediatric Obesity Prevention Intervention. HEALTH BEHAVIOR AND POLICY REVIEW 2017; 4:357-366. [PMID: 30680291 PMCID: PMC6342286 DOI: 10.14485/hbpr.4.4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is value in having parents choose which behaviors to address in obesity interventions, but it is unknown whether they choose behaviors that will effectively impact healthy growth. This study assessed whether child behaviors or parent intention to change behaviors were associated with behaviors parents chose to discuss. METHODS Parent intention to change specific behaviors and time spent discussing behaviors was coded during intervention sessions. RESULTS Child activity, screen-time, energy intake, breakfast, and family meals were associated with time spent discussing these behaviors. Fewer associations were seen between parent intention and time spent discussing these behaviors. CONCLUSIONS Results suggest that in interventions allow choice, parents may choose to discuss the weight-related behaviors their children need to address.
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Affiliation(s)
| | | | - Simone A French
- Division of Epidemiology & Community Health, University of Minnesota
| | | | - Robert W Jeffery
- Division of Epidemiology & Community Health, University of Minnesota
| | - Rona L Levy
- School of Social Work, University of Washington
| | - Shelby L Langer
- Center for Health Promotion & Disease Prevention, Arizona State University
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Messiah SE, Lebron C, Moise R, Sunil Mathew M, Sardinas K, Chang C, Palenzuela J, Walsh J, Shelnutt KP, Spector R, Altare F, Natale R. Healthy caregivers-healthy children (HC2) phase 2: Integrating culturally sensitive childhood obesity prevention strategies into childcare center policies. Contemp Clin Trials 2017; 53:60-67. [DOI: 10.1016/j.cct.2016.12.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/01/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022]
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Draxten M, Flattum C, Fulkerson J. An Example of How to Supplement Goal Setting to Promote Behavior Change for Families Using Motivational Interviewing. HEALTH COMMUNICATION 2016; 31:1276-83. [PMID: 26940585 PMCID: PMC4961042 DOI: 10.1080/10410236.2015.1062975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The purpose of this study was to describe the components and use of motivational interviewing (MI) within a behavior change intervention to promote healthful eating and family meals and prevent childhood obesity. The Healthy Home Offerings via the Mealtime Environment (HOME) Plus intervention was part of a two-arm randomized-controlled trial and included 81 families (children 8-12 years old and their parents) in the intervention condition. The intervention included 10 monthly, 2-hour group sessions and 5 bimonthly motivational/goal-setting phone calls. Data were collected for intervention families only at each of the goal-setting calls and a behavior change assessment was administered at the 10th/final group session. Descriptive statistics were used to analyze the MI call data and behavior assessment. Overall group attendance was high (68% attending ≥7 sessions). Motivational/goal-setting phone calls were well accepted by parents, with an 87% average completion rate. More than 85% of the time, families reported meeting their chosen goal between calls. Families completing the behavioral assessment reported the most change in having family meals more often and improving home food healthfulness. Researchers should use a combination of delivery methods using MI when implementing behavior change programs for families to promote goal setting and healthful eating within pediatric obesity interventions.
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Affiliation(s)
- Michelle Draxten
- a Department of Family Medicine and Community Health , University of Minnesota
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Jalali MS, Sharafi-Avarzaman Z, Rahmandad H, Ammerman AS. Social influence in childhood obesity interventions: a systematic review. Obes Rev 2016; 17:820-32. [PMID: 27138986 DOI: 10.1111/obr.12420] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/23/2016] [Indexed: 01/08/2023]
Abstract
The objective of this study is to understand the pathways through which social influence at the family level moderates the impact of childhood obesity interventions. We conducted a systematic review of obesity interventions in which parents' behaviours are targeted to change children's obesity outcomes, because of the potential social and environmental influence of parents on the nutrition and physical activity behaviours of children. PubMed (1966-2013) and the Web of Science (1900-2013) were searched, and 32 studies satisfied our inclusion criteria. Results for existing mechanisms that moderate parents' influence on children's behaviour are discussed, and a causal pathway diagram is developed to map out social influence mechanisms that affect childhood obesity. We provide health professionals and researchers with recommendations for leveraging family-based social influence mechanisms to increase the efficacy of obesity intervention programmes. © 2016 World Obesity.
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Affiliation(s)
- M S Jalali
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Z Sharafi-Avarzaman
- Faculty of Economics and Business Administration, Goethe University Frankfurt, Frankfurt, Germany
| | - H Rahmandad
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - A S Ammerman
- Center for Health Promotion & Disease Prevention, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Grassi E, Evans A, Ranjit N, Pria SD, Messina L. Using a mixed-methods approach to measure impact of a school-based nutrition and media education intervention study on fruit and vegetable intake of Italian children. Public Health Nutr 2016; 19:1952-63. [PMID: 26857624 PMCID: PMC10271168 DOI: 10.1017/s1368980015003729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate the impact of a school-based nutrition and media education intervention on the promotion of fruit and vegetable consumption to help prevent childhood obesity. DESIGN The 10-week-long intervention included sessions on nutrition education and media literacy. It also included a health communication media-based campaign workshop during which the children created posters, newsletters and video commercials related to fruits and vegetables targeted to their parents. For evaluation purposes, the study utilized a mixed-methods approach, including a quasi-experimental study (with one intervention group and one control group) and a focus group study. SETTING Four different elementary schools in Treviso (Veneto Region of Italy) agreed to participate in the research. SUBJECTS The target population for the study included 10-year-old Italian children and their parents. RESULTS Data indicate that this intervention was effective for children but not for parents. Evaluation results show that the intervention was effective in significantly increasing children's fruit and vegetable intake (P<0·05) and all psychosocial determinants (P<0·05). CONCLUSIONS The study results confirm the efficacy of a school-based health and media education intervention to address the children's obesity issue and, in particular, to increase children's fruit and vegetable intake. The study also opens a new perspective on the theoretical constructs investigated, because the development of 'ability of expression' could be considered one of the most important factors to determine the efficacy of the intervention.
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Affiliation(s)
- Elena Grassi
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
| | - Alexandra Evans
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Street Suite 6.300, Austin, TX 78701, USA
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Street Suite 6.300, Austin, TX 78701, USA
| | | | - Laura Messina
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
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Sosa ET, Parra-Medina D, He M, Trummer V, Yin Z. ¡Miranos! (Look at Us! We Are Healthy!). Health Promot Pract 2016; 17:675-81. [DOI: 10.1177/1524839915623762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parent interventions for childhood obesity prevention have traditionally experienced low participation rates or used passive methods such as newsletters. In contrast, the ¡Miranos! intervention home-based activities included parent-led face-to-face meetings delivered after school, take-home bags with educational materials, and scavenger hunt games to deliver health information to Head Start families regarding nutrition, physical activity, and healthy growth promotion for their preschooler. This study employed a quasi-experimental design with three intervention centers (two that received only center-based activities and one that received center- and home-based activities) and one comparison center. Data were collected on participating Head Start children and their parents/guardians and included parent attendance, parent health message recall through intercept interviews, parent knowledge through pre- and posttests, and family supportive behaviors and child health behaviors through a parent questionnaire. Parents/guardians that received both center- and home-based activities significantly increased knowledge scores (t = 2.50, degrees of freedom = 123, p < .05) and family supportive behaviors from baseline to follow-up (t = 2.12, degrees of freedom = 122, p < .05). This study demonstrates the effects home-based interventions can have when coupled with center-based activities and implemented in the center at the end of the school day.
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Affiliation(s)
- Erica T. Sosa
- The University of Texas at San Antonio, San Antonio, TX, USA
| | - Deborah Parra-Medina
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Meizi He
- The University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Zenong Yin
- The University of Texas at San Antonio, San Antonio, TX, USA
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Bucher Della Torre S, Dudley-Martin F, Kruseman M. 'Croque&bouge': A feasible and acceptable programme for obesity prevention in preschoolers at risk and their parents. SAGE Open Med 2016; 3:2050312115574365. [PMID: 26770769 PMCID: PMC4679228 DOI: 10.1177/2050312115574365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 01/27/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To conceptualize and pilot test a programme of three workshops aiming to prevent the development of overweight in susceptible preschool children. METHODS Three workshops were conducted, targeting both parents and children. The curriculum for parents included discussions on feeding responsibilities, healthy eating, taste development, neophobia and physical activity recommendations. Children participated in various play activities with fruits and vegetables and read stories about hunger and satiety feelings. Recruitment was organized through paediatricians and child-care centres. Evaluation of the programme focused on feasibility, adequacy for children's age, parents' perception of impact and, for children, change of the ability to recognize and willingness to taste fruits and vegetables. RESULTS A total of 21 children and one of their parents participated in the programme. The programme was found to be feasible and adequate for the targeted community. Parents reported perceiving a positive impact of the intervention; however, this finding was not statistically significant. The major difficulty was identifying and recruiting families and engaging the parents in a discussion about weight. CONCLUSIONS This short programme aiming to improve parents' ability to offer healthy environment and promote healthy eating behaviour was feasible and acceptable for families with young children. When developing and implementing such programmes, close collaboration with paediatricians and other health providers should be sought in order to identify and reach children at risk of obesity and their family.
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Affiliation(s)
- Sophie Bucher Della Torre
- Nutrition and Dietetics Department, School of Health Professions - Geneva (HEdS-GE), University of Applied Sciences Western Switzerland (HES-SO), Carouge, Switzerland
| | - Fiona Dudley-Martin
- Nutrition and Dietetics Department, School of Health Professions - Geneva (HEdS-GE), University of Applied Sciences Western Switzerland (HES-SO), Carouge, Switzerland
| | - Maaike Kruseman
- Nutrition and Dietetics Department, School of Health Professions - Geneva (HEdS-GE), University of Applied Sciences Western Switzerland (HES-SO), Carouge, Switzerland
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Sherwood NE, JaKa MM, Crain AL, Martinson BC, Hayes MG, Anderson JD. Pediatric Primary Care-Based Obesity Prevention for Parents of Preschool Children: A Pilot Study. Child Obes 2015; 11:674-82. [PMID: 26478951 PMCID: PMC4677530 DOI: 10.1089/chi.2015.0009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Healthy Homes/Healthy Kids Preschool (HHHK-Preschool) pilot program is an obesity prevention intervention integrating pediatric care provider counseling and a phone-based program to prevent unhealthy weight gain among 2- to 4-year-old children at risk for obesity (BMI percentile between the 50th and 85th percentile and at least one overweight parent) or currently overweight (85th percentile ≤ BMI < 95th percentile). The aim of this randomized, controlled pilot study was to evaluate the feasibility, acceptability, and potential efficacy of the HHHK-Preschool intervention. METHODS Sixty parent-child dyads recruited from pediatric primary care clinics were randomized to: (1) the Busy Bodies/Better Bites Obesity Prevention Arm or the (2) Healthy Tots/Safe Spots safety/injury prevention Contact Control Arm. Baseline and 6-month data were collected, including measured height and weight, accelerometry, previous day dietary recalls, and parent surveys. Intervention process data (e.g., call completion) were also collected. RESULTS High intervention completion and satisfaction rates were observed. Although a statistically significant time by treatment interaction was not observed for BMI percentile or BMI z-score, post-hoc examination of baseline weight status as a moderator of treatment outcome showed that the Busy Bodies/Better Bites obesity prevention intervention appeared to be effective among children who were in the overweight category at baseline relative to those who were categorized as at risk for obesity (p = 0.04). CONCLUSIONS HHHK-Preschool pilot study results support the feasibility, acceptability, and potential efficacy in already overweight children of a pediatric primary care-based obesity prevention intervention integrating brief provider counseling and parent-targeted phone coaching. What's New: Implementing pediatric primary care-based obesity interventions is challenging. Previous interventions have primarily involved in-person sessions, a barrier to sustained parent involvement. HHHK-preschool pilot study results suggest that integrating brief provider counseling and parent-targeted phone coaching is a promising approach.
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Affiliation(s)
- Nancy E. Sherwood
- HealthPartners Institute for Education and Research, Bloomington, MN
| | - Meghan M. JaKa
- HealthPartners Institute for Education and Research, Bloomington, MN
| | - A. Lauren Crain
- HealthPartners Institute for Education and Research, Bloomington, MN
| | | | - Marcia G. Hayes
- HealthPartners Institute for Education and Research, Bloomington, MN
| | - Julie D. Anderson
- HealthPartners Institute for Education and Research, Bloomington, MN
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26
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Kunin-Batson AS, Seburg EM, Crain AL, Jaka MM, Langer SL, Levy RL, Sherwood NE. Household factors, family behavior patterns, and adherence to dietary and physical activity guidelines among children at risk for obesity. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:206-15. [PMID: 25748634 PMCID: PMC4428928 DOI: 10.1016/j.jneb.2015.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/19/2015] [Accepted: 01/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe the proportion of children adhering to recommended physical activity and dietary guidelines, and examine demographic and household correlates of guideline adherence. DESIGN Cross-sectional (pre-randomization) data from a behavioral intervention trial designed to prevent unhealthy weight gain in children. PARTICIPANTS A total of 421 children (aged 5-10 years) at risk for obesity (body mass index percentile, 70-95). MAIN OUTCOMES MEASURED Physical activity (accelerometry), screen time (parent survey), and fruit and vegetable and sugar-sweetened beverage intake (24-hour dietary recall). ANALYSIS Proportions meeting guidelines were calculated. Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for (1) physical activity (≥ 60 min/d), (2) screen time (≤ 2 h/d), (3) fruit and vegetable intake (≥ 5 servings/d), and (4) sugar-sweetened beverage avoidance. RESULTS Few children met more than 1 guideline. Only 2% met all 4 recommended guidelines and 19% met none. Each guideline had unique sociodemographic and domain-specific household predictors (ie, availability of certain foods and beverages, media, and active play and exercise equipment). CONCLUSIONS AND IMPLICATIONS Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others. Results have implications for the development of interventions to affect children's weight-related behaviors and growth trajectories.
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Affiliation(s)
| | | | - A Lauren Crain
- HealthPartners Institute for Education and Research, Bloomington, MN
| | - Meghan M Jaka
- HealthPartners Institute for Education and Research, Bloomington, MN
| | - Shelby L Langer
- School of Social Work, University of Washington, Seattle, WA
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Bloomington, MN
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Lunn PL, Roberts S, Spence A, Hesketh KD, Campbell KJ. Mothers' perceptions of Melbourne InFANT Program: informing future practice. Health Promot Int 2015; 31:614-22. [PMID: 25769978 DOI: 10.1093/heapro/dav004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Intervention programs to prevent childhood obesity are more likely to be successful when mothers are involved and engaged. Yet programs that involve mothers do not often employ process evaluation to identify aspects of the intervention that participants enjoyed or viewed as useful. The aims of this study were to describe how participants of the Melbourne InFANT Program-an early childhood obesity prevention intervention-engaged in the program and perceived its usefulness. Process evaluation data were collected at multiple time points during and after the intervention, using mixed methods drawing upon both quantitative and qualitative data. Results from short surveys (n = 271) and interview transcripts (n = 26) revealed that the Melbourne InFANT Program was perceived as useful and relevant by most (82-93%) participants. The formats through which the knowledge and skills were delivered were considered concise and effective, and aspects considered particularly useful included group sessions and advice on practical strategies to minimize stress around mealtimes. Findings from this study are important to inform future practice and the development of interventions which are well received by participants.
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Affiliation(s)
- Priscilla L Lunn
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Sanae Roberts
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, VIC, Australia
| | - Alison Spence
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, VIC, Australia
| | - Kylie D Hesketh
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, VIC, Australia
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, VIC, Australia
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Dulin Keita A, Risica PM, Drenner KL, Adams I, Gorham G, Gans KM. Feasibility and acceptability of an early childhood obesity prevention intervention: results from the healthy homes, healthy families pilot study. J Obes 2014; 2014:378501. [PMID: 25405026 PMCID: PMC4227329 DOI: 10.1155/2014/378501] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/01/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study examined the feasibility and acceptability of a home-based early childhood obesity prevention intervention designed to empower low-income racially/ethnically diverse parents to modify their children's health behaviors. METHODS We used a prospective design with pre-/posttest evaluation of 50 parent-child pairs (children aged 2 to 5 years) to examine potential changes in dietary, physical activity, and sedentary behaviors among children at baseline and four-month follow-up. RESULTS 39 (78%) parent-child pairs completed evaluation data at 4-month follow-up. Vegetable intake among children significantly increased at follow-up (0.54 cups at 4 months compared to 0.28 cups at baseline, P = 0.001) and ounces of fruit juice decreased at follow-up (11.9 ounces at 4 months compared to 16.0 ounces at baseline, P = 0.036). Sedentary behaviors also improved. Children significantly decreased time spent watching TV on weekdays (P < 0.01) and also reduced weekend TV time. In addition, the number of homes with TV sets in the child's bedroom also decreased (P < 0.0013). CONCLUSIONS The findings indicate that a home-based early childhood obesity prevention intervention is feasible, acceptable and demonstrates short-term effects on dietary and sedentary behaviors of low-income racially/ethnically diverse children.
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Affiliation(s)
- Akilah Dulin Keita
- Institute for Community Health Promotion, Department of Behavioral and Social Sciences, Brown University, P.O. Box G-S121-8, Providence, RI 02908, USA
| | - Patricia M. Risica
- Institute for Community Health Promotion, Department of Behavioral and Social Sciences, Brown University, P.O. Box G-S121-8, Providence, RI 02908, USA
| | - Kelli L. Drenner
- Kinesiology & Health Science, Stephen F. Austin State University, P.O. Box 13015 SFA Station, Nacogdoches, TX 75962, USA
| | - Ingrid Adams
- School of Human Environmental Sciences, University of Kentucky, Lexington, KY 40506, USA
| | - Gemma Gorham
- Institute for Community Health Promotion, Department of Behavioral and Social Sciences, Brown University, P.O. Box G-S121-8, Providence, RI 02908, USA
| | - Kim M. Gans
- Center for Health, Intervention, and Prevention, Department of Human Development and Family Studies, University of Connecticut, 348 Mansfield Road, Unit 1058, Room 320, Storrs, CT 06269, USA
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Laws R, Campbell KJ, van der Pligt P, Russell G, Ball K, Lynch J, Crawford D, Taylor R, Askew D, Denney-Wilson E. The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review. BMC Public Health 2014; 14:779. [PMID: 25084804 PMCID: PMC4137086 DOI: 10.1186/1471-2458-14-779] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/17/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families. METHODS Searches of major electronic databases identified articles published from 1993-2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity. RESULTS Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m(2) to -0.54 kg/m(2) for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3-5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery. CONCLUSION There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required. TRIAL REGISTRATION PROSPERO Registration no: CRD42013006536.
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Affiliation(s)
- Rachel Laws
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Karen J Campbell
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Paige van der Pligt
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Georgina Russell
- />Faculty of Health, University of Technology, Sydney, NSW Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Kylie Ball
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - John Lynch
- />School of Population Health, University of Adelaide, Adelaide, SA Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - David Crawford
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Rachael Taylor
- />University of Otago, Dunedin, New Zealand
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Deborah Askew
- />Inala Indigenous Health Service, Inala, QLD, Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Elizabeth Denney-Wilson
- />Faculty of Health, University of Technology, Sydney, NSW Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
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Stein D, Weinberger-Litman SL, Latzer Y. Psychosocial perspectives and the issue of prevention in childhood obesity. Front Public Health 2014; 2:104. [PMID: 25133140 PMCID: PMC4116804 DOI: 10.3389/fpubh.2014.00104] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/15/2014] [Indexed: 11/13/2022] Open
Abstract
A dramatic increase in childhood overweight/obesity has been recognized globally over the past 50 years. This observed increase may reflect genetic, as well as psychological, environmental, and socio-cultural influences. In the first part of this review, we present an updated summary of the psychosocial factors associated with this change and discuss possible ways in which they operate. Among these factors, lower socio economic status (in both industrialized and non-industrialized countries), being female, belonging to a minority group, and being exposed to adverse life events may all be associated with a greater risk of childhood overweight/obesity. These influences may be mediated via a variety of mechanisms, in particular above-average food intake of low nutritional quality and reduction in physical activity. Other important psychosocial mediators include the influence of the family and peer environment, and exposure to the media. In the second part of the review, we discuss the potential of psychosocial prevention programs to intervene in the processes involved in the rise of childhood overweight/obesity. Two points are emphasized. First, prevention programs should be multidisciplinary, combining the knowledge of experts from different professions, and taking into consideration the important role of the family environment and relevant influential social organizations, particularly school. Second, effective change is unlikely to occur without large-scale programs carried out on a public policy level.
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Affiliation(s)
- Daniel Stein
- Pediatric Psychosomatic Department, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center , Tel Hashomer , Israel ; Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | | | - Yael Latzer
- Faculty of Social Welfare and Health Sciences, Haifa University , Haifa , Israel ; Eating Disorders Clinic, Psychiatric Division, Rambam Medical Center , Haifa , Israel
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Role modeling as an early childhood obesity prevention strategy: effect of parents and teachers on preschool children's healthy lifestyle habits. J Dev Behav Pediatr 2014; 35:378-87. [PMID: 25007060 DOI: 10.1097/dbp.0000000000000074] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effectiveness of a child care center-based parent and teacher healthy lifestyle role-modeling program on child nutrition and physical activity outcomes. METHODS Child care centers (N = 28) serving low-income families were randomized to intervention or control arms. Intervention centers (N = 12) implemented (1) menu modifications, (2) a child's healthy lifestyle curriculum, and (3) an adult (teacher- and parent-focused) healthy lifestyle role-modeling curriculum. Control centers (N = 16) received an attention control safety curriculum. Nutrition and physical activity data were collected at the beginning (T1) and at the end (T2) of the school year. Exploratory factor analysis identified positive and negative nutrition and physical activity practices by children, parents, and teachers. RESULTS Intervention parents' baseline (β = .52, p < .0001) and school year consumption (β = .47, p < .0001) of fruits/vegetables significantly increased their children's consumption of fruits/vegetables from T1 to T2. Intervention parents significantly influenced a decrease in children's junk food consumption (β = -.04, p < .05), whereas control parents significantly influenced an increase in their children's junk food consumption (β = .60, p < .001) from T1 to T2. Control children showed a significant increase in junk food consumption (β = .11, p = .01) and sedentary behavior (β = .09, p < .005) from T1 to T2. Teachers did not significantly influence preschool-age children's nutrition or physical activity patterns from T1 to T2. CONCLUSIONS Parent nutrition and physical activity patterns significantly influence their preschool-age children's consumption of fruits/vegetables, junk food, and level of sedentary behavior. Future obesity prevention intervention efforts targeting this age group should include parents as healthy lifestyle role models for their children.
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Chen Q, Goto K, Wolff C, Bianco-Simeral S, Gruneisen K, Gray K. Cooking up diversity. Impact of a multicomponent, multicultural, experiential intervention on food and cooking behaviors among elementary-school students from low-income ethnically diverse families. Appetite 2014; 80:114-22. [PMID: 24845782 DOI: 10.1016/j.appet.2014.05.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 04/19/2014] [Accepted: 05/12/2014] [Indexed: 11/26/2022]
Abstract
This study evaluated the impact of a pilot intervention promoting ethnic produce through classroom food demonstrations, tastings and home cooking activities among ethnically diverse elementary-school children ages 5-8 years old and their family members in Northern California. A total of 604 intervention students from four schools participated in classroom food demonstrations and tasting activities using seven food recipes. The control group included 600 students from two additional schools. Each recipe featured one vegetable from Latino, Hmong, or mainstream American cultures. Intervention students also received food kits containing ingredients to take home for each recipe. Mixed methods of quantitative student and parent pre-post surveys, parent feedback surveys, and qualitative focus groups were used to evaluate the intervention. Generalized estimating equations were used for survey data analysis. Qualitative data from parent focus groups were analyzed based on the principles of grounded theory. Both quantitative and qualitative results revealed that intervention students increased familiarity, preferences, and consumption of the featured vegetables and significantly increased their involvement in food preparation at home. Qualitative results showed that children were actively involved in food preparation at home. In addition, the intervention helped parents increase their appreciation for new foods and recipes. The results suggest that promoting locally grown ethnic produce to children is effective in increasing their consumption of a variety of vegetables and their involvement in food preparation at home.
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Affiliation(s)
- Qiong Chen
- Department of Nutrition and Food Sciences, California State University, Chico, CA, USA
| | - Keiko Goto
- Department of Nutrition and Food Sciences, California State University, Chico, CA, USA; Center for Nutrition and Activity Promotion, California State University, Chico, CA, USA.
| | - Cindy Wolff
- Department of Nutrition and Food Sciences, California State University, Chico, CA, USA; Center for Nutrition and Activity Promotion, California State University, Chico, CA, USA
| | - Stephanie Bianco-Simeral
- Department of Nutrition and Food Sciences, California State University, Chico, CA, USA; Center for Nutrition and Activity Promotion, California State University, Chico, CA, USA
| | - Kristin Gruneisen
- Center for Nutrition and Activity Promotion, California State University, Chico, CA, USA
| | - Katharine Gray
- Department of Mathematics and Statistics, California State University, Chico, CA, USA
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Gordon ES, Tucker P, Burke SM, Carron AV. Effectiveness of physical activity interventions for preschoolers: a meta-analysis. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2013; 84:287-294. [PMID: 24261007 DOI: 10.1080/02701367.2013.813894] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The purpose of the meta-analysis was to examine the effectiveness of physical activity interventions on physical activity participation among preschoolers. A secondary purpose was to investigate the influence of several possible moderator variables (e.g., intervention length, location, leadership, type) on moderate-to-vigorous physical activity (MVPA). METHOD Nine databases were systematically searched for physical activity interventions. Studies were included if they contained statistics necessary to compute an effect size (ES), were written in or translated into English, examined physical activity in preschoolers, incorporated a physical activity intervention, and targeted preschool-aged children. Fifteen studies satisfied these criteria. ESs were calculated using a random-effects model. RESULTS Results indicated that overall, interventions had a small-to-moderate effect on general physical activity (Hedges g = 0.44, p < .05, n = 73 ESs) and a moderate effect on MVPA (Hedges g = 0.51, p < .05, n = 39 ESs). The greatest effects for MVPA were identified for interventions that were less than 4 weeks in duration, were offered in an early-learning environment, were led by teachers, involved outdoor activity, and incorporated unstructured activity. CONCLUSIONS This meta-analysis provides an overview and synthesis of physical activity interventions and highlights effective strategies for future interventions aimed at increasing physical activity levels among preschoolers.
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McGillivray J, McVilly K, Skouteris H, Boganin C. Parental factors associated with obesity in children with disability: a systematic review. Obes Rev 2013; 14:541-54. [PMID: 23527696 DOI: 10.1111/obr.12031] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/05/2013] [Accepted: 02/21/2013] [Indexed: 11/30/2022]
Abstract
The current literature on obesity in typically developing children shows that the family context, and specifically the way parents parent their children are major determinants of childhood obesity. The influence of these factors on obesity in children with disability, however, remains unclear. A systematic review of the literature was undertaken to identify the parental and parenting risk factors associated with obesity in children and adolescents with disability. Articles were identified through Medline, Academic Search Complete, PsycINFO, ProQuest, ISI, CINAHL, Cochrane and Scopus databases. There was no restriction on publication dates. The inclusion criteria were empirical papers that tested associations between parental and parenting risk factors and obesity in children and adolescents with intellectual and other developmental disabilities. Only 11 studies met the selection criteria and subsequently included in this review. Results suggest that obesity in children and adolescents with disability may be associated with socioeconomic status; parents' body mass index, perception and attitude towards their children's weight and physical activity; and levels of activity in both parents and children. Firm conclusions about these associations cannot be reached, however, due to mixed findings and methodological limitations of the studies. Recommendations for future research are provided.
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Affiliation(s)
- J McGillivray
- School of Psychology, Deakin University, Burwood, Victoria, Australia.
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Bender MS, Nader PR, Kennedy C, Gahagan S. A culturally appropriate intervention to improve health behaviors in Hispanic mother-child dyads. Child Obes 2013; 9:157-63. [PMID: 23514697 PMCID: PMC3621339 DOI: 10.1089/chi.2012.0118] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Obesity interventions targeting Hispanic preschool children are still nascent, and few are culturally appropriate. We evaluated the feasibility of a culturally relevant 9-month intervention program to improve health behaviors in low-income Mexican mothers with 3- to 5-year-old children. METHODS A community engagement approach was used to culturally and linguistically tailor an intervention program that was pilot tested with 33 mother-child dyads enrolled from a large California urban health center. A one-group, pretest-posttest design assessed changes in children's consumption of sugar-sweetened beverages (SSB), mothers' pedometer steps, and BMI. Data were collected at baseline, postintervention and at 6 months postintervention. RESULTS At postintervention, SSB consumption had significantly decreased for soda and other sugary drinks with a modest reduction for 100% juice. Consumption of water had significantly increased, whereas milk had an increased trend. Maternal step counts significantly increased for weekdays by 69% and weekend days by 49%. Overall, maternal BMI decreased while children's BMI% remained stable. At 6 months postintervention, children's soda and juice consumption reverted toward baseline levels, as did maternal step counts, but children's consumption of sugary drinks remained lower, while water and milk remained higher. CONCLUSIONS Findings suggest that a culturally relevant intervention was feasible for improving target health behaviors in a low-income Mexican community. Future work should assess an enhanced intervention including a maintenance phase for long-term adherence to health behavior changes and influence on maternal and child BMI.
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Affiliation(s)
- Melinda S Bender
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA 94143-0606, USA.
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Walters KL, LaMarr J, Levy RL, Pearson C, Maresca T, Mohammed SA, Simoni JM, Evans-Campbell T, Fredriksen-Goldsen K, Fryberg S, Jobe JB. Project həli?dx(w)/Healthy Hearts Across Generations: development and evaluation design of a tribally based cardiovascular disease prevention intervention for American Indian families. J Prim Prev 2013; 33:197-207. [PMID: 22965622 DOI: 10.1007/s10935-012-0274-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
American Indian and Alaska Native (AIAN) populations are disproportionately at risk for cardiovascular disease (CVD), diabetes, and obesity, compared with the general US population. This article describes the həli?dx(w)/Healthy Hearts Across Generations project, an AIAN-run, tribally based randomized controlled trial (January 2010-June 2012) designed to evaluate a culturally appropriate CVD risk prevention program for AI parents residing in the Pacific Northwest of the United States. At-risk AIAN adults (n = 135) were randomly assigned to either a CVD prevention intervention arm or a comparison arm focusing on increasing family cohesiveness, communication, and connectedness. Both year-long conditions included 1 month of motivational interviewing counseling followed by personal coach contacts and family life-skills classes. Blood chemistry, blood pressure, body mass index, food intake, and physical activity were measured at baseline and at 4- and 12-month follow-up times.
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Affiliation(s)
- Karina L Walters
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA 98105, USA.
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Fitzgibbon ML, Stolley MR, Schiffer L, Kong A, Braunschweig CL, Gomez-Perez SL, Odoms-Young A, Van Horn L, Christoffel KK, Dyer AR. Family-based hip-hop to health: outcome results. Obesity (Silver Spring) 2013; 21:274-83. [PMID: 23532990 PMCID: PMC3465637 DOI: 10.1002/oby.20269] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 05/04/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This pilot study tested the feasibility of Family-Based Hip-Hop to Health, a school-based obesity prevention intervention for 3-5-year-old Latino children and their parents, and estimated its effectiveness in producing smaller average changes in BMI at 1-year follow-up. DESIGN AND METHODS Four Head Start preschools administered through the Chicago Public Schools were randomly assigned to receive a Family-Based Intervention (FBI) or a General Health Intervention (GHI). RESULTS Parents signed consent forms for 147 of the 157 children enrolled. Both the school-based and family-based components of the intervention were feasible, but attendance for the parent intervention sessions was low. Contrary to expectations, a downtrend in BMI Z-score was observed in both the intervention and control groups. CONCLUSIONS While the data reflect a downward trend in obesity among these young Hispanic children, obesity rates remained higher at 1-year follow-up (15%) than those reported by the National Health and Nutrition Examination Survey (2009-2010) for 2-5-year-old children (12.1%). Developing evidence-based strategies for obesity prevention among Hispanic families remains a challenge.
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Affiliation(s)
- Marian L Fitzgibbon
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
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GreenMills LL, Davison KK, Gordon KE, Li K, Jurkowski JM. Evaluation of a childhood obesity awareness campaign targeting head start families: designed by parents for parents. J Health Care Poor Underserved 2013; 24:25-33. [PMID: 23727962 PMCID: PMC5500217 DOI: 10.1353/hpu.2013.0096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Communities for Healthy Living program used a community-based participatory research (CBPR) approach to empower Head Start parents in designing and pilot testing a multi-component family-centered obesity prevention program. One program component was a childhood obesity awareness campaign addressing common parental misconceptions about obesity. The campaign was designed by a community advisory board of parents to target specific issues identified within their own community. Results from pre-post intervention surveys (N=108) showed that campaign exposure was high; 92% of responding parents reported noticing the campaign. Parents also demonstrated significant increases in awareness of childhood obesity, along with decreases in obesity-related misconceptions. Findings, supported by growing literature on CBPR, suggest a CBPR approach to campaign development is an effective strategy to promote parent awareness of childhood obesity.
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Affiliation(s)
- Lisa L GreenMills
- Department of Health Policy, Management and Behavior, University at Albany School of Public Health, 1 University Place, Rensselaer, NY 12144; USA
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O'Dwyer MV, Fairclough SJ, Knowles Z, Stratton G. Effect of a family focused active play intervention on sedentary time and physical activity in preschool children. Int J Behav Nutr Phys Act 2012; 9:117. [PMID: 23025568 PMCID: PMC3495835 DOI: 10.1186/1479-5868-9-117] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 09/25/2012] [Indexed: 11/30/2022] Open
Abstract
Background Early childhood provides a window of opportunity for the promotion of physical activity. Given the limited effectiveness of interventions to date, new approaches are needed. Socio-ecological models suggest that involving parents as intervention targets may be effective in fostering healthier lifestyles in children. This study describes the effectiveness of a family-focused ‘Active Play’ intervention in decreasing sedentary time and increasing total physical activity in preschool children. Method Seventy-seven families were recruited from 8 randomly selected SureStart children’s centres in the North West of England. Centres were randomly assigned to either an intervention (n = 4) or a comparison group (n = 4). Parents and children in the intervention group received a 10-week active play programme delivered by trained active play professionals; this included an activity and educational component. Families in the comparison group were asked to maintain their usual routine. Each participating parent and child wore a uni-axial accelerometer for 7 days at baseline and post-test. Week and weekend day sedentary time and total physical activity adjusted for child- and home- level covariates were analysed using multilevel analyses. Results Significant intervention effects were observed for sedentary time and physical activity for both week and weekend days. Children in the intervention group engaged in 1.5% and 4.3% less sedentary time during week and weekend days, respectively and 4.5% and 13.1% more physical activity during week and weekend days, respectively than children in the comparison group. Parent’s participation in sport and their physical activity levels, child’s sex, availability of media in the home and attendance at organised activities were significant predictors of sedentary time and physical activity in this age group. Conclusion A 10-week family focused active play intervention produced positive changes in sedentary time and total physical activity levels in preschool children. Specific covariates were identified as having a significant effect on the outcome measures. Moreover, children whose parents were active engaged in less sedentary time and more physical activity suggesting that parent’s activity habits are mediators of physical activity engagement in this age group.
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Affiliation(s)
- Mareesa V O'Dwyer
- Early Childhood Ireland, Hainault House, Belgard Square, Tallaght, Dublin 24, Ireland.
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Agrawal T, Hoffman JA, Ahl M, Bhaumik U, Healey C, Carter S, Dickerson D, Nethersole S, Griffin D, Castaneda-Sceppa C. Collaborating for impact: a multilevel early childhood obesity prevention initiative. FAMILY & COMMUNITY HEALTH 2012; 35:192-202. [PMID: 22617410 DOI: 10.1097/fch.0b013e318250bc25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article presents Healthy Kids, Healthy Futures, a multilevel initiative in Boston, Massachusetts, which brings major institutions' missions and resources together to address early childhood obesity prevention. Programming is designed to facilitate healthy eating and physical activity in preschool children's home, school, and community environments by engaging parents and early childhood educators in the places where they live, learn, and play. This article describes how established interventions were implemented in a novel setting to engage the parents of children attending Head Start and staff, and presents pilot data from the first 2 years of the initiative. Healthy Kids, Healthy Futures is a feasible initiative, which has shown concrete, positive results that can be replicated.
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Affiliation(s)
- Tara Agrawal
- Institute of Urban Health Research, Bouve College of Sciencé, Northeastern University, USA
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41
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Le Thai C, Prelip M, Toller Erausquin J, Slusser W. Lessons Learned from the Development and Implementation of a Parent Nutrition Education Program with Low-Income Latina Mothers in an Urban School District Setting. AMERICAN JOURNAL OF HEALTH EDUCATION 2012. [DOI: 10.1080/19325037.2012.10599242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Chan Le Thai
- a Department of Communication , University of California, Social Science and Media Studies , Santa Barbara, 4423, Santa Barbara , CA , 93108
| | - Michael Prelip
- b Department of Community Health Sciences, Fielding School of Public Health , University of California Los Angeles , Los Angeles , CA , 90095
| | | | - Wendelin Slusser
- d Department of Pediatrics and the Fielding School of Public Health , University of California Los Angeles , Los Angeles , CA , 90095
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Sekhobo JP, Egglefield K, Edmunds LS, Shackman G. Evidence of the adoption and implementation of a statewide childhood obesity prevention initiative in the New York State WIC Program: the NY Fit WIC process evaluation. HEALTH EDUCATION RESEARCH 2012; 27:281-291. [PMID: 22052217 DOI: 10.1093/her/cyr100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Process evaluations are critical in determining whether outcome evaluations are warranted. This study assessed the extent to which a childhood obesity prevention initiative, NY Fit WIC, was adopted and implemented by the New York State Supplemental Nutrition Program for Women, Infants and Children (WIC). Process data came from qualitative telephone interviews of 101 WIC local agency directors, following NY Fit WIC trainings. Activities were summarized and cross-tabulated by target level (i.e. participant, staff, agency or community) and by theoretical construct (i.e. knowledge promotion, skill building, self-efficacy or role modeling). Approximately 528 activities were reported across all WIC agencies. When activities were grouped into similar categories, 123 unique activities were identified. Agencies were more likely to implement physical activity-related activities (67%) than nutrition-related activities (33%). The majority of activities targeted WIC participants (47%) and staff (22%) and focused on skill building/self-efficacy (67%) among participants and on role modeling (61%) among staff. The involvement of all agencies shows a high level of adoption of the initiative. The diverse number of activities suggests that WIC local agencies tailored implementation to match their resources and clients' needs as planned. These results suggest that an outcome evaluation is warranted to determine whether meaningful behavioral changes occurred among WIC participants and staff.
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Affiliation(s)
- Jackson P Sekhobo
- Evaluation.nalysis Unit, Bureau of Administration and Evaluation, Division of Nutrition, NY State Department of Health, 150 Broadway, Riverview Center, Suite 517, Menands, NY 12204, USA.
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Slusser W, Frankel F, Robison K, Fischer H, Cumberland WG, Neumann C. Pediatric overweight prevention through a parent training program for 2-4 year old Latino children. Child Obes 2012; 8:52-9. [PMID: 22799481 DOI: 10.1089/chi.2011.0060] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Latino preschool children in the United States are at high risk for obesity. The objective of this study was to measure over a one-year period whether a parent training based on social learning theory combined with evidence-based interventions to promote optimal nutrition and physical activity will reduce the upward trend of BMI z-scores in groups of 2–4 year old Latino children living in low-income households. METHODS Seven weekly classes with 2 booster classes were delivered to low-income Latino parents with 2–4 year old children. A randomized controlled pilot study evaluated the effectiveness of the intervention that contrasts 61 children whose parents were randomized to receive Parent Training (PT) with 60 Wait-list (WL) subjects. Forty subjects did not attend the one-year follow up assessment, resulting in 81 subjects who have measurements for both baseline and one-year follow up assessments. To adjust for differential dropout rates and missing observations, imputation of missing data was done using a carefully constructed model that included relevant independent variables. RESULTS There were no significant subject differences between groups at baseline for family characteristics and BMI categories for child and parent. Children in the intervention group decreased their BMI z-scores significantly on average by .20 (SE= .08) compared to children in the control group who increased z scores on average by .04 (SE=.09) at one year (P<.05). CONCLUSIONS Parent training is effective to reduce the risk of overweight in preschool Latino children living in low-income households. The findings need to be examined in a larger sample of children.
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Affiliation(s)
- Wendy Slusser
- Mattel Children’s Hospital, Department of Pediatrics, University of California-Los Angeles School of Medicine, Los Angeles, CA 90024,
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Shin SH, Miller DP. A longitudinal examination of childhood maltreatment and adolescent obesity: results from the National Longitudinal Study of Adolescent Health (AddHealth) Study. CHILD ABUSE & NEGLECT 2012; 36:84-94. [PMID: 22398304 DOI: 10.1016/j.chiabu.2011.08.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 08/02/2011] [Accepted: 08/13/2011] [Indexed: 05/22/2023]
Abstract
OBJECTIVES We sought to explore the association between childhood maltreatment (e.g., neglect, physical and sexual abuse) and longitudinal growth trajectories of body mass index (BMI) from adolescence to young adulthood. METHODS We used latent curve modeling to examine data from the National Longitudinal Study of Adolescent Health (N=8,471), pooling years 1995-2008. Relative weight was indicated by BMI. RESULTS Children who experienced neglect had a faster average rate of BMI growth over time compared to children who experienced no childhood maltreatment. In addition, the co-occurrence of childhood neglect and physical abuse was related to increased levels of BMI at baseline, even after adjustment for 14 separate child and parental demographic and psychosocial characteristics. Parental obesity and education, child birth place, and family income were also associated with both baseline BMI and the rate of change in BMI over time. CONCLUSION Childhood neglect plays a role in the development of adolescent obesity. Future research should examine potential mediators or moderators of the longitudinal relation between childhood neglect and adolescent and young adult obesity including impulsivity, depression, and compulsive eating behavior.
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Affiliation(s)
- Sunny Hyucksun Shin
- Boston University, School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
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Kuhl ES, Clifford LM, Stark LJ. Obesity in preschoolers: behavioral correlates and directions for treatment. Obesity (Silver Spring) 2012; 20:3-29. [PMID: 21760634 DOI: 10.1038/oby.2011.201] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Nearly 14% of American preschoolers (ages 2-5) are obese (BMI ≥ 95th percentile for age and gender), yet this group has received little attention in the obesity intervention literature. This review examines what is known about behavioral correlates of obesity in preschoolers and the developmental context for lifestyle modification in this age group. Information was used to critically evaluate existing weight management prevention and intervention programs for preschoolers and formulate suggestions for future intervention research development. A systematic search of the medical and psychological/behavioral literatures was conducted with no date restrictions, using PubMed, PsycInfo, and MEDLINE electronic databases and bibliographies of relevant manuscripts. Evidence suggests several modifiable behaviors, such as sugar sweetened beverage intake, television use, and inadequate sleep, may differentiate obese and healthy weight preschoolers. Developmental barriers, such as food neophobia, food preferences, and tantrums challenge caregiver efforts to modify preschoolers' diet and activity and parental feeding approaches, and family routines appear related to the negative eating and activity patterns observed in obese preschoolers. Prevention programs yield modest success in slowing weight gain, but their effect on already obese preschoolers is unclear. Multi-component, family-based, behavioral interventions show initial promise in positive weight management for already obese preschoolers. Given that obesity intervention research for preschoolers is in its infancy, and the multitude of modifiable behavioral correlates for obesity in this age group, we discuss the use of an innovative and efficient research paradigm (Multiphase Optimization Strategy; MOST) to develop an optimized intervention that includes only treatment components that are found to empirically reduce obesity in preschoolers.
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Affiliation(s)
- Elizabeth S Kuhl
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2011:CD001871. [PMID: 22161367 DOI: 10.1002/14651858.cd001871.pub3] [Citation(s) in RCA: 754] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear. OBJECTIVES This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?" SEARCH METHODS The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted. SELECTION CRITERIA The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings). MAIN RESULTS This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I(2)=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m(2) (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m(2) (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m(2) (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m(2) (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies. AUTHORS' CONCLUSIONS We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:· school curriculum that includes healthy eating, physical activity and body image· increased sessions for physical activity and the development of fundamental movement skills throughout the school week· improvements in nutritional quality of the food supply in schools· environments and cultural practices that support children eating healthier foods and being active throughout each day· support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)· parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activitiesHowever, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.
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Affiliation(s)
- Elizabeth Waters
- Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, Melbourne School of Population Health, The University of Melbourne, Level 5/207 Bouverie St, Carlton, VIC, Australia, 3010
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Bender MS, Clark MJ. Cultural Adaptation for Ethnic Diversity: A Review of Obesity Interventions for Preschool Children. CALIFORNIAN JOURNAL OF HEALTH PROMOTION 2011; 9:40. [PMID: 24159268 PMCID: PMC3805036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Obesity disproportionately affects U.S. ethnic minority preschool children, placing them at risk for obesity related co-morbidities and premature death. Effective culturally appropriate interventions are needed to improve health behaviors and reduce obesity in young high-risk minority children, while their behaviors are still developing. All known obesity intervention studies (e.g., diet and physical activity) since 2000 targeting U.S. ethnic minority preschool children were reviewed. Five electronic databases and eight published literature reviews were used to identify the studies. Intervention studies without identified ethnic minority participants were excluded. Ten obesity interventions studies met the review criteria. Published cultural adaptation guidelines were used to develop a mechanism to analyze, score, and rank the intervention adaptations. Cultural adaptations varied widely in rigor, depth, and breadth. Results indicated a relative absence of appropriately adapted obesity interventions for ethnic minority groups, suggesting a need for more rigorous cultural adaptation guidelines when designing obesity interventions for diverse ethnicities. Culturally appropriate adaptations appeared to enhance intervention relevance, effectiveness, and feasibility. The purpose of this literature review was to evaluate 1) the type and extent of cultural adaptations strategies applied to the interventions, and 2) how these adaptations related to the study outcomes.
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Affiliation(s)
- Melinda S. Bender
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, California 92110, Phone; (858) 535-8211, Fax: (858) 535-8211
| | - Mary Jo Clark
- Hahn School of Nursing and Health Science, University of San Diego
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Salmon J, Tremblay MS, Marshall SJ, Hume C. Health risks, correlates, and interventions to reduce sedentary behavior in young people. Am J Prev Med 2011; 41:197-206. [PMID: 21767728 DOI: 10.1016/j.amepre.2011.05.001] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 04/05/2011] [Accepted: 05/04/2011] [Indexed: 11/25/2022]
Abstract
CONTEXT Opportunities for young people to be sedentary have increased during leisure time, study time, and transportation time. PURPOSE This review paper focuses on sedentary behaviors among young people aged 2-18 years and includes evidence of the relationship between sedentary behavior and health risk indicators, an overview of public health recommendations, the prevalence of key sedentary behaviors, evidence of correlates of sedentary behavior and the effectiveness of interventions to reduce sedentary behaviors. EVIDENCE ACQUISITION Although this is a narrative style review and not systematic, where possible, findings from relevant review papers were summarized and a search of more recent literature was performed using computer-based databases such as PubMed, Google Scholar, ERIC, PsycINFO, Social Science Index, SportDiscus, and Health Reference Center - Academic. EVIDENCE SYNTHESIS Young people spend 2-4 hours per day in screen-based behaviors and 5-10 hours per day sedentary. Ethnicity, sociodemographic status, having a TV set in the bedroom, and parental behavior appear to be the most consistent correlates of TV viewing time; however, few recent studies aiming to reduce TV viewing or sedentary time among young people have been successful. CONCLUSIONS A growing body of evidence supports the development of public health recommendations to limit the time spent in screen-based behaviors. More research is needed to examine the prospective and experimental evidence of associations between overall sedentary time and health, determinants of sedentary behaviors other than screen-based behaviors, and interventions to reduce overall sedentary time or even alternative sedentary behaviors, such as transport- or education-related sitting time.
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Affiliation(s)
- Jo Salmon
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Australia.
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Davison KK, Edmunds LS, Young LM, Sarfoh VS, Wyker BA, Sekhobo JP. Feasibility of increasing childhood outdoor play and decreasing television viewing through a family-based intervention in WIC, New York State, 2007-2008. Prev Chronic Dis 2011; 8:A54. [PMID: 21477494 PMCID: PMC3103559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Active Families is a program developed to increase outdoor play and decrease television viewing among preschool-aged children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Our objective was to assess its feasibility and efficacy. METHODS We implemented Active Families in a large WIC clinic in New York State for 1 year. To this end, we incorporated into WIC nutrition counseling sessions a community resource guide with maps showing recreational venues. Outcome measures were children's television viewing and time playing outdoors and parents' behaviors (television viewing, physical activity), self-efficacy to influence children's behaviors, and parenting practices specific to television viewing. We used a nonpaired pretest and posttest design to evaluate the intervention, drawing on comparison data from 3 matched WIC agencies. RESULTS Compared with the children at baseline, the children at follow-up were more likely to watch television less than 2 hours per day and play outdoors for at least 60 minutes per day. Additionally, parents reported higher self-efficacy to limit children's television viewing and were more likely to meet physical activity recommendations and watch television less than 2 hours per day. CONCLUSION Results suggest that it is feasible to foster increased outdoor play and reduced television viewing among WIC-enrolled children by incorporating a community resource guide into WIC nutrition counseling sessions. Future research should test the intervention with a stronger evaluation design in multiple settings, with more diverse WIC populations, and by using more objective outcome measures of child behaviors.
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Affiliation(s)
| | - Lynn S. Edmunds
- Evaluation and Analysis Unit, Bureau of Administration and Evaluation, Division of Nutrition, New York State Department of Health
| | - Laurie M. Young
- University at Albany, State University of New York, Albany, New York
| | - Vanessa S. Sarfoh
- University at Albany, State University of New York, Albany, New York
| | - Brett A. Wyker
- Division of Nutrition, New York State Department of Health, Albany, New York
| | - Jackson P. Sekhobo
- Division of Nutrition, New York State Department of Health, Albany, New York
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Skouteris H, McCabe M, Swinburn B, Newgreen V, Sacher P, Chadwick P. Parental influence and obesity prevention in pre-schoolers: a systematic review of interventions. Obes Rev 2011; 12:315-28. [PMID: 20492538 DOI: 10.1111/j.1467-789x.2010.00751.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Obesity is difficult to reverse in older children and adults and calls have been made to implement obesity prevention strategies during the formative pre-school years. Childhood obesity experts suggest that prevention of overweight in the pre-school years should focus on parents, because parental beliefs, attitudes, perceptions and behaviours appear to contribute to children's development of excessive weight gain. While evidence suggests that parental variables may be instrumental in the development of obesity, there has been no systematic evaluation of whether intervening to change such variables will positively influence the development of excess adiposity during the pre-school years. This paper is a conceptual and methodological review of the literature on the parental variables targeted in interventions designed to modify risk factors for obesity by promoting healthy eating and/or physical activity and/or reducing sedentary behaviours in families of children aged 2-6 years. There were significant methodological limitations of existing studies and the scientific study of this area is in its infancy. However, the results suggest that the modification of parental variables known to be associated with obesity-promoting behaviours in pre-school children may show promise as an obesity prevention strategy; further research is needed.
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Affiliation(s)
- H Skouteris
- School of Psychology, Faculty of Health, Medicine, Nursing and Behavioural Sciences, Deakin University, Melbourne, Australia.
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